Huitfeldt Sola Kristoffer, Brismar Torkel, Lorant Tomas, Fränneby Ulf, Larsson Oskar, Genberg Helena
Division of Radiology, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
Department of Radiology, Karolinska University Hospital, Stockholm, Sweden.
Hernia. 2025 Aug 19;29(1):256. doi: 10.1007/s10029-025-03452-2.
Incisional hernia (IH) is a common complication after kidney transplantation, impacting morbidity and quality of life. This retrospective study aimed to identify IH risk factors and develop a predictive model.
We retrospectively analysed 667 adult kidney transplant recipients (2010-2017) from two transplant centres. Medical records were screened for symptoms of abdominal wall impairment, postoperative CT scans assessed, and factors associated with IH analysed. Using the Penn Hernia Calculator, hernia probability was calculated. Adult kidney recipients transplanted 2018-2019 in Region Stockholm served as verification cohort. In a subgroup with preoperative CT scans after progression to stage 5 chronic kidney disease, muscle quality was assessed. A wound closure technique using self-locking knots, two-layer parietal running suture, and a suture-to-wound length ratio ≥ 4:1 was termed "modified Israelsson."
Logistic regression identified age, BMI, renal replacement therapy duration, and wound closure technique as independent IH risk factors (pseudo R² = 0.15). The "modified Israelsson method" reduced IH odds by 83% (OR = 0.17). Sarcopenia and myosteatosis were not significant predictors. In the verification cohort, the model had 76% sensitivity for high-risk patients (≥ 10% predicted IH risk), outperforming the Penn Hernia Calculator.
Wound closure technique is the strongest modifiable predictor of symptomatic IH identified in this cohort. The "modified Israelsson method" is a straightforward technique that shows strong promise for reducing incisional hernia (IH) rates and appears highly implementable. Our findings also underscore the value of developing specific predictive models for kidney transplant recipients, as generic tools may not capture crucial intraoperative factors.
切口疝（IH）是肾移植术后常见的并发症，会影响发病率和生活质量。这项回顾性研究旨在确定IH的危险因素并建立预测模型。
我们回顾性分析了来自两个移植中心的667例成年肾移植受者（2010 - 2017年）。筛查病历以寻找腹壁损伤症状，评估术后CT扫描结果，并分析与IH相关的因素。使用宾夕法尼亚疝计算器计算疝发生概率。2018 - 2019年在斯德哥尔摩地区接受移植的成年肾移植受者作为验证队列。在进展到5期慢性肾病后进行术前CT扫描的亚组中，评估肌肉质量。使用自锁结、两层腹膜连续缝合且缝合线与伤口长度比≥4:1的伤口闭合技术被称为“改良以色列松技术”。
逻辑回归确定年龄、体重指数、肾脏替代治疗持续时间和伤口闭合技术为独立的IH危险因素（伪R² = 0.15）。“改良以色列松方法”使IH发生几率降低了83%（OR = 0.17）。肌肉减少症和肌脂肪变性不是显著的预测因素。在验证队列中，该模型对高危患者（预测IH风险≥10%）的敏感性为76%，优于宾夕法尼亚疝计算器。
伤口闭合技术是该队列中确定的有症状IH的最强可改变预测因素。“改良以色列松方法”是一种简单的技术，在降低切口疝（IH）发生率方面显示出巨大潜力，且似乎易于实施。我们的研究结果还强调了为肾移植受者开发特定预测模型的价值，因为通用工具可能无法捕捉关键的术中因素。
